Provider Demographics
NPI:1649928763
Name:GONZALEZ, GUELDYS ROSA
Entity type:Individual
Prefix:MS
First Name:GUELDYS
Middle Name:ROSA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4863 CAREFREE COVE BLVD LOT 127
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-4680
Mailing Address - Country:US
Mailing Address - Phone:786-238-5855
Mailing Address - Fax:
Practice Address - Street 1:4863 CAREFREE COVE BLVD LOT 127
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-4680
Practice Address - Country:US
Practice Address - Phone:786-238-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-130537106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician